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(Editor’s Note: What follows is an excerpt of an article that appeared in the April issue of Concussion Litigation Reporter)

A Pennsylvania state appeals court has reversed a trial court, and given new life to the claims of two student-athletes, who sued their coaches and their college after suffering head and spinal injuries during football practice.

In so ruling, the panel of judges found that questions remain about whether the actions of the defendants constituted gross negligence and whether the waiver they had signed should act as a shield to gross negligence claims.

This case involves personal injuries suffered by the plaintiffs on March 29, 2010, while they were participating in a tackling drill during the first day of spring contact football practice at a non-profit junior college in northeastern Pennsylvania and a member of the National Junior College Athletic Association (NJCAA). Traditionally, the school employed two athletic trainers to support the football program. In June and July 2009, both athletic trainers tendered their resignations to the school.

Sport-related concussion, one of the most complex injuries in sports medicine, is the focus of a new special issue of the Journal of Athletic Training, the scientific publication of the National Athletic Trainers’ Association.

“Over the last 20 years, our understanding of concussion mechanics, injury assessment and management has increased dramatically. We’ve made great strides with regard to education, research and legislation,” says special issue Guest Editor Steven Broglio, PhD, ATC, director, Neurotrauma Research Laboratory, University of Michigan. “Having the right multidisciplinary medical team in place, including the athletic trainer, who plays an important role in injury prevention and treatment, is vital. Our universal goal is to reduce the risk of injury and ensure a gold standard of care should concussion occur.”

Concussions during sport and recreation occur as often as 3.8 million times a year,1 resulting in up to seven injuries per minute every day of the year in the United States. Although each patient requires individual management, 90 percent of concussed athletes recover by day seven after injury.2 Concussive injuries compose 8.9 percent of all high school and 5.8 percent of all college athletic injuries.3

Head-impact sensors have limited applications to concussion diagnosis but may provide sideline staff with estimates of athlete exposure and real-time data to monitor players.

Given that concussion risk is inﬂuenced by many factors in addition to impact biomechanics, viewing an athlete’s head-impact data may provide context for the clinician working on the sidelines, but impact sensors should not replace clinical judgment.

Compared with high school athletes who had access to an athletic trainer, those without such access were less knowledgeable about concussion.

Access to an athletic trainer was not linked to high school athletes’ concussion-reporting percentages. However, such access was related to 10 reasons for not reporting a concussion.

The most common reasons for not reporting a concussion were not wanting to lose playing time, not thinking the injury was serious enough to require medical attention and not wanting to let the team down.

Per 10,000 athlete-exposures, the rates of sport-related concussion were highest in football (9.21), boys’ lacrosse (6.65), and girls’ soccer (6.11).

Among sex-comparable sports, the rate of sport-related concussion was 56 percent higher in girls than in boys.

Most athletes with sport-related concussions returned to play after seven days, despite resolution of symptoms in a smaller proportion within one week.

“No sports medicine topic is more polarizing than concussion, and today’s standard of care supersedes where we were just a decade ago,” says Broglio. “With validated measures, more and more of the guesswork is being removed from the process. While many questions persist about more sophisticated diagnostic measures, rehabilitation and long-term effects of injury, we continue to make great progress, remain current on research and new techniques and provide the best possible care for our patients at any level of sport or activity.”

A confidential settlement agreement has reportedly been reached between the parties in Walen v. Portland State University, et al., in the Circuit Court of the State of Oregon, Multnomah County, No. 14CV12218.

While the financial terms weren’t disclosed, attorneys for plaintiff Zachary Walen noted that Portland State University (PSU) has agreed to update the concussion policy used by its sports medicine staff. The changes reportedly include:

The risk of developing post-concussion syndrome will be included in the education provided to student-athletes and the training provided to coaches and staff.

The training of coaches and staff will include an explanation regarding the concussion healing process, which depending on the student athlete’s condition, can take weeks and possibly longer.

Student-athletes will be informed of their right to seek, at their own cost, a return-to-play opinion from a physician who is not a member of the PSU Sports Medicine Staff. The most conservative opinion will be followed. All student-athletes will be informed of this option during the education provided to student-athletes.

At the student-athlete’s request and with his or her consent, the parent(s) of a concussed student-athlete will be informed if their son or daughter has been diagnosed with a concussion and when the student-athlete has been cleared to return to full sport participation. All student-athletes will be informed of this option during the education provided to student-athletes.

The initial injury to Walen, who sought $5 million in damages, occurred on opening day in September of 2012 during the linebacker’s first game as a Viking. It is uncontested that in the fourth quarter of that game that Walen suffered a head injury after a direct blow to the head. Though coaches and staff allegedly failed to identify the concussion in the aftermath of the hit, Walen’s parents brought him to the hospital shortly after the game, where he was diagnosed with a concussion.